NeighborShare Recipient Application

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This application lets us know you're interested in receiving box delivery. Once we process your application we will follow-up with you and let you know how soon we can match you with a delivery volunteer!

Delivery is currently only available in the Midlands counties of South Carolina.

Email Address

First Name *

Last Name *

Street Address *

City *

State *

ZIP *

Phone *

Example: 123-456-7890

Please let us know how you would describe the part of town where you live.

Columbia Area: *

Downtown

Northeast

St. Andrews/Irmo

Cayce/West Columbia

Fort Jackson/East Columbia

Hopkins/Eastover

I do not live in Columbia

If you live outside of Columbia, please let us know your county. (Select from drop down menu.)

We are currently only able to serve the South Carolina counties listed in the drop-down menu below. If you are not in one of these counties, select "Other" and we will keep your information on file to follow-up as we expand in the future.

Other County

Thanks for requesting assistance through NeighborShare. Can you tell us a little more about you?

Do you receive SNAP/EBT? *

Yes

Do you have a primary care physician? *

Yes

If yes, please provide your doctor's name:

Do you have your own transportation? *

Yes

Please Answer Yes or No to the following two questions:

Within the past 12 months, I worried whether our food would run out before I had money to buy more. *

Yes

Within the past 12 months, the food I bought just didn’t last and I didn’t have money to get more. *

Yes

Please share anything else about yourself that you would like us to know.

More about me:

Almost done!

Please select your level of assistance needed below (Check all that apply.) *

I request to be partnered with someone who can deliver to me.

I request to be partnered with someone who can place my order for me.

Required

Thanks so much for filling this application out! Please hit the "SUBMIT" button below and we'll be in touch!

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